NURSES are being trained to perform an increasing number of doctors' tasks in public hospitals as governments try to cut costs, reduce waiting lists and get more out of their workforce.

In a trend worrying some specialists, public hospital nurses are now doing cystoscopies and colonoscopies (endoscopies of the bladder and bowel) in certain cases, instead of physicians who specialise in urology and gastroenterology.

There are also hopes nurses will be trained to sedate patients for the procedures instead of anaesthetists, and even administer epidurals.

About 12 nurses have been trained or are being trained to do endoscopies at several hospitals in Victoria, including Monash Medical Centre and the Royal Melbourne, Austin, Alfred and Western hospitals. The move follows nurses being trained to perform X-rays in some rural hospitals, a step that has infuriated radiographers who say it is dangerous and could lead to misdiagnoses and higher cancer risk.

Austin Hospital chief executive Dr Brendan Murphy said his hospital had been given government grants to train nurses to carry out cystoscopies on patients who had had cancer and needed regular checks to ensure it had not returned.

Other nurses were being trained to carry out colonoscopies in cases including where a positive result had been returned under the national bowel cancer screening program.

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Dr Murphy said the nurses, who received comprehensive training and worked with doctors nearby in case they needed help, cost the hospital less, freed doctors to do more complex work and helped cut waiting lists.

He said training nurses to do such jobs was an innovative way of stretching them to their full potential while sparing them more basic tasks such as washing and feeding patients - jobs he said less skilled and lower paid nursing assistants could do.

Such changes were necessary in the face of rising demand for healthcare, increasingly unsustainable costs and predicted workforce shortages, he said.

''We're stuffed unless we restructure our health workforce,'' he said. ''We're always talking about shortages … all the predictions say in 2025 we might be anywhere between 60,000 to 120,000 nurses short across Australia if we continue to rely on university graduates.''

Modelling also forecasts a shortage of about 2700 doctors by 2025.

Dr Murphy, a trained kidney specialist who is also on the board of the Commonwealth statutory authority Health Workforce Australia, said nurses could also be trained to do epidurals in maternity hospitals, which spent large amounts of money paying anaesthetists to tend to birthing women 24 hours a day.

''There is no reason why you couldn't have obstetric epidurals done by nurses,'' he said, adding many anaesthetists were often bored with such routine aspects of their job. ''For 99 per cent of the time, they are just squirting in drugs, putting someone to sleep and then once a month something dramatic happens and they have a life to save and get excited.''

Leading anaesthetists said Dr Murphy's comments showed a ''monumental lack of understanding'' about their work. They accused him of denigrating their profession because of an industrial dispute he was having with Austin anaesthetists over how much time they spend doing research and other duties outside of theatre time.

While some nurses are already trained to assist with light or ''conscious sedation'' under doctors' supervision in radiology clinics for example, Australian Society of Anaesthetists president Dr Richard Grutzner said it could be dangerous for nurses to manage deeper sedation and epidurals because the procedures required expertise to prevent and manage life-threatening complications.

''There is no such thing as minor anaesthesia. Even a perfectly fit young person can have major complications from anaesthesia,'' he said.

''I'm talking mainly about major drug allergies and anaphylaxis.''

While some gastroenterologists and urologists said training nurses to do endoscopies was safe for a limited

range of patients, others were concerned they could miss crucial things that doctors would pick up. Urologists, gastroenterologists and anaesthetists spend about three to six years training in their speciality after their initial medical studies.

Monash Medical Centre head of urology Mark Frydenberg said although he was confident nurse cystoscopists at his hospital were providing safe care to a limited group of patients, their work was being closely monitored to prove it.

He said the risk of a patient being injured during a flexible cystoscopy was extraordinarily low, with about one in 20,000 to 50,000 patients experiencing trauma. ''It's virtually impossible to perforate the bladder,'' he said.

But Urological Society of Australia and New Zealand president Dr Stephen Ruthven said until there was evidence showing nurses were not missing cancers or other significant details, the society would not have a formal position on the matter.

Gastroenterological Society of Australia president Professor William Sievert said that despite mixed feelings, the group had decided to help train nurses on the proviso they would be doing colonoscopies in a team environment for low-risk patients.

He said data from Britain, where more than 300 nurses now perform endoscopies, showed it was safe, but Australian nurses would now have to be assessed.

Assistant secretary of the Victorian branch of the Australian Nursing Federation Paul Gilbert said although some nurses were keen to take on more complex tasks, the union was concerned about any suggestion registered nurses were doing tasks that could be performed by less trained and unregistered assistants.

He said nurses enjoyed looking after people holistically and that included carefully washing and feeding them at times to detect problems that might need attention.

Dr Murphy said health professionals and their unions were disingenuously trying to scare the public into thinking it was unsafe for people to be trained to do new things, because they feared losing territory.